Organisational determinants and consequences of diagnostic discrepancy in two large patient groups in the emergency departments: a national study of consecutive episodes between 2008 and 2016
Dublin Core
Title
Organisational determinants and consequences of diagnostic discrepancy in two large patient groups in the emergency departments: a national study of consecutive episodes between 2008 and 2016
Subject
Emergency service, hospital, Denmark, Diagnostic error, Organization and administration, Emergency
medicine
medicine
Description
Background: Diagnostic discrepancy (DD) is a common phenomenon in healthcare, but little is known about its
organisational determinants and consequences. Thus, the aim of the study was to evaluate this among selected
emergency department (ED) patients.
Method: We conducted an observational study including all consecutive ED patients (hip fracture or erysipelas) in
the Danish healthcare sector admitted between 2008 and 2016. DD was defined as a discrepancy between
discharge and admission diagnoses. Episode and department statistics were retrieved from Danish registers. We
conducted a survey among all 21 Danish EDs to gather information about organisational determinants. To estimate
the results while adjusting for episode- and department-level heterogeneity, we used mixed effect models of ED
organisational determinants and 30-day readmission, 30-day mortality and episode costs (2018-DKK) of DDs.
Results: DD was observed in 2308 (3.3%) of 69,928 hip fracture episodes and 3206 (8.5%) of 37,558 erysipelas
episodes. The main organisational determinant of DD was senior physicians (nonspecific medical specialty) being
employed at the ED (hip fracture: odds ratio (OR) 2.74, 95% confidence interval (CI) 2.15–3.51; erysipelas: OR 3.29,
95% CI 2.65–4.07). However, 24-h presence of senior physicians (nonspecific medical specialty) (hip fracture) and
availability of external senior physicians (specific medical specialty) (both groups) were negatively associated with
DD. DD was associated with increased 30-day readmission (hip fracture, mean 9.45% vs 13.76%, OR 1.46, 95% CI
1.28–1.66, p < 0.001) and episode costs (hip fracture, 61,681 DKK vs 109,860 DKK, log cost 0.58, 95% CI 0.53–0.63,
p < 0.001; erysipelas, mean 20,818 DKK vs 56,329 DKK, log cost 0.97, 95% CI 0.92–1.02, p < 0.001) compared with
episodes without DD.
organisational determinants and consequences. Thus, the aim of the study was to evaluate this among selected
emergency department (ED) patients.
Method: We conducted an observational study including all consecutive ED patients (hip fracture or erysipelas) in
the Danish healthcare sector admitted between 2008 and 2016. DD was defined as a discrepancy between
discharge and admission diagnoses. Episode and department statistics were retrieved from Danish registers. We
conducted a survey among all 21 Danish EDs to gather information about organisational determinants. To estimate
the results while adjusting for episode- and department-level heterogeneity, we used mixed effect models of ED
organisational determinants and 30-day readmission, 30-day mortality and episode costs (2018-DKK) of DDs.
Results: DD was observed in 2308 (3.3%) of 69,928 hip fracture episodes and 3206 (8.5%) of 37,558 erysipelas
episodes. The main organisational determinant of DD was senior physicians (nonspecific medical specialty) being
employed at the ED (hip fracture: odds ratio (OR) 2.74, 95% confidence interval (CI) 2.15–3.51; erysipelas: OR 3.29,
95% CI 2.65–4.07). However, 24-h presence of senior physicians (nonspecific medical specialty) (hip fracture) and
availability of external senior physicians (specific medical specialty) (both groups) were negatively associated with
DD. DD was associated with increased 30-day readmission (hip fracture, mean 9.45% vs 13.76%, OR 1.46, 95% CI
1.28–1.66, p < 0.001) and episode costs (hip fracture, 61,681 DKK vs 109,860 DKK, log cost 0.58, 95% CI 0.53–0.63,
p < 0.001; erysipelas, mean 20,818 DKK vs 56,329 DKK, log cost 0.97, 95% CI 0.92–1.02, p < 0.001) compared with
episodes without DD.
Creator
Line Stjernholm Tipsmark , Børge Obel, Tommy Andersson and Rikke Søgaard
Publisher
BMC Emergency Medicine
Date
(2021) 21:145
Contributor
Fajar bagus W
Format
PDF
Language
Indonesia
Type
Text
Files
Collection
Citation
Line Stjernholm Tipsmark , Børge Obel, Tommy Andersson and Rikke Søgaard, “Organisational determinants and consequences of diagnostic discrepancy in two large patient groups in the emergency departments: a national study of consecutive episodes between 2008 and 2016,” Repository Horizon University Indonesia, accessed November 22, 2024, https://repository.horizon.ac.id/items/show/3909.